Abstract
This paper aims to examine the risks of excessive engagement in plastic surgery among adolescents, the factors that motivate this age group to change their appearance, and potential health risks. Unrealistically high beauty standards and the availability of appropriate procedures have become the main reasons for the spread of plastic surgery among adolescents and the emergence of pressing ethical concerns. Objectives of this research were to answer what the effects of cosmetic beauty standards on adolescents are and what impact does plastic surgery have on a teen’s physical and mental health. As a background for research, relevant academic resources and articles contain critical assessments and controversial cases were used and rationale for the problem. A personal interview with peers who has had plastic surgery at young age was also carried out. The research results confirm that various external influences, including social media, celebrity impacts, or bullying are factors that dictate fashion of appearance and motivation for plastic surgery among adolescents. In conclusion, the propensity toward PS in teenagers needs to be addressed by introducing psychological assistance as a necessary stage before considering PS as a solution.
Introduction
Engagement in plastic surgery among adolescents is an ambiguous phenomenon since, when not supported by a substantial reason such as a serious medical condition, it appears to be motivated purely by the reason to follow questionable beauty standards and is likely to be harmful in the long term. Personally, I have been affected by the plastic surgery industry since I have a close friend who has suffered after undergoing several unnecessary cosmetic surgeries, which is why I am willing to address the issue of plastic surgeries in this paper. In Asia, it is common to undergo cosmetic procedures during adolescence. In fact, many parents encourage their children to get plastic surgery at a young age, because they believe that better looks will secure a better future for their children. The majority of my friends have undergone invasive cosmetic procedures from as young as 13. However, I have noticed a high percentage of plastic surgery addiction among those who underwent operations at a younger age. My definition of plastic surgery addiction is when an individual undergoes an invasive cosmetic procedure at least once every 3 months. I noticed this as a real problem when I visited one of my friends during her recovery after plastic surgery. She had just gotten the v-line surgery, which is a jaw reconstruction process involving shaving off the jawline to make the face look slimmer and younger, as well as her fourth correction for double-eyelid surgery. Previously, I had been neutral about cosmetic procedures, but it scared me after seeing her having difficulty breathing, coughing up blood, and having seizures. A few days after my visit, her boyfriend called me saying that she was in a coma for 3 days. I was overwhelmed with sadness and anger. I was angry at her boyfriend for not talking her out of the surgery, and I was angry at myself for being an enabler and not stopping her. Thankfully she woke up the next morning. Once she had fully recovered, we went to have lunch together. During lunch, however, she explained that she had booked a rhinoplasty appointment and a forehead reduction surgery. I expressed my concern to persuade her not to take further surgery, but she did not listen. In retrospect, I should have been more consistent in my arguments, yet I was too shocked and scared to keep my thoughts in order. I tried my best to persuade her that she was perfect the way she was and that plastic surgeries were a product or a greedy industry making a fortune of unsuspecting teenagers. However, jumping from one topic to another, having little evidence to support my claims, and being the only person who was trying to dissuade her, I eventually failed to convince her.
Although teenage plastic surgery may seem uncommon, it is a very real problem. Today, the role of plastic surgery is much more prevalent than ever before. One might presume that plastic surgeries are less widespread in the U.S., where the specified industry overlaps mostly with the ones of music and movies since celebrities tend to be the target customers of most American plastic surgery clinics. However, statistics show that the role of plastic surgeries has risen among general audiences in the U.S. recently. Specifically, in 2007, the U.S. was the country with the largest number of plastic surgeries made (Bureau of Labor Statistics, 2019). Modern capabilities of this medical field have advanced in popularity and technology. As cosmetic surgery has seen a sharp rise in patients, surgeons are also seeing an increase in adolescent patients. This spread in popularity among young teens should send alarm signals for future generations as beauty standards have shifted to become unattainable without invasive cosmetic procedures. It appears that the increasing engagement of plastic surgery among adolescents affects the psychology of teenagers and society negatively. But I may be clouded in judgment from seeing my friend in pain. I aim to better understand the topic of plastic surgery from various perspectives so that I can put myself in my friend’s shoes. I, therefore, intend to answer a two-part research question as follows. What are the effects of cosmetic beauty standards on adolescents? What impact does plastic surgery have on a teen’s physical and mental health?
To understand why there has been an increasing number of younger patients for plastic surgery, I must first determine the background of this trend. Thus, I intend to analyze the various factors that prompt teenagers to seek the services of plastic surgeons. Weigh the positive and negative effects of teenage plastic surgery and understand any long-term results on physical and mental health. Additionally, I attempt to cross-examine Asia and America to see the cultural similarities and differences regarding views and attitudes towards plastic surgery. This comparison enables me to analyze how much of an impact culture has on teenagers deciding to undergo cosmetic procedures. Based on my experience, I assume that there is a direct correlation between adolescent plastic surgery and the development of plastic surgery addiction later in life, but I wonder if this holds true for countries where plastic surgery is more stigmatized.
Major Factors That Impact Teens To Undergo Surgery
Childhood Influence and Societal Beauty Standards
Even though the understanding of beauty standards is formed in adolescent and adult periods, specific childhood trauma or negative experience may influence the desire to transform one’s appearance. According to a study conducted by Nesbitt and her team, who have substantial experience in the field of Kinesiology and Physical Education, humans have the disposition to compare themselves to others to gain an accurate self-evaluation (Nesbitt, et al. 2019). Nesbitt et al. (2019) have approached the issue from the Cognitive Behavior Theory (CBT) perspective, thus outlining the main factors inciting the decision to do plastic surgeries and conform to the established beauty standard. This behavior usually develops during the preschool years as children watch the people around them. The social comparison theory, however, is also learned through playing with toys that represent the human figure. When a child is given a salient representation of a body that presents unrealistic standards, such as Barbie or Bratz, he or she activates and increases the self-schema. Namely, an individual creates a mental idealized image of oneself, at the same time establishing the need and the urgency to meet the set unachievable goal. This algorithm “is thought to lead to a heightened awareness of appearance-related information” (Nesbitt, et al. 2019, p.15). The expansion of appearance self-schema towards unrealistic body proportions is associated with anxiety within young children. This increases their risk of developing a negative body image that may later develop body dysmorphia, weight-related anxiety, and general body dissatisfaction. It appears that the development of self-schema lies at the core of the problems associated with the desire to undergo unnecessary plastic surgeries.
Different manifestations of dissatisfaction are the result of impaired views on beauty. Nesbitt et al. (2019) note that children who are under ten are more likely to partake in an upward social comparison (comparison between them and whom they consider better) when exposed to external beauty standards. Furthermore, the social comparison theory is also learned by watching cartoons that imitate the human figure. Similar to Barbie, Disney princess characters also portray this thin ideal of having big eyes and a perfectly proportioned body. In contrast, Disney villains are illustrated to represent the societal definition of unattractiveness. It looks to me that this type of cartoon exposure emphasizes the prevalent stereotype of beauty being good and ugly equating to evil. Frequent exposure to this message strengthens and drives the expansion of the appearance self-schema and pressures children to fit into a beauty ideal while alienating their peers that do not. My friend appears to have been influenced in a similar way since our popular culture tends to use the described cues as shorthand for creating specific positive and negative characters, thus cementing our idea of what a visually appealing face should look like.
However, after receiving backlash from the body-positivity movement, many big corporations such as Disney and Barbie are trying to fight the issues of negative self-image that may have been bred through their products. Barbie has since then created a line of dolls that represent various body types from height to size. Alongside this, Disney has been drawing the animations as more cartoonish and straying further from the human figure. Additionally, Disney has shifted its storyline to feature more independent and strong princesses and represent attractive characters as having both good and bad qualities. Although both Disney and Barbie have shifted the message targeted towards children, different forms of media continue to promote harmful messages by maintaining the idea of impaired beauty standards that a child learns early. In the place of Barbie, new doll toys that promote unrealistic beauty standards have appeared, e.g. monster high dolls, Rica dolls. And although Barbie has created a more size-inclusive variety for their doll figures, the animations and movies continue to feature the unrealistically thin and perfect original Barbie. The image of a girl with a perfect figure and appearance has long become fashionable and is perceived as a given. Therefore, I believe that the role of media content is significant in shaping specific trends and attitudes. For example, looking at my personal experience, my little niece refused to play with dolls that had a traditionally childlike, a bit chubby appearance and instead preferred a Barbie and the dolls whose bodies were even more disproportionate, such as Bratz.
Social Media
Apps like Instagram, Tiktok, or Snapchat dominate society amongst teens; these sites are extremely picture-oriented and allow users to comment, like, and share posts. This, in turn, is fraught with biased views and creates a phenomenon known as the objectification theory. According to de Vries et al. (2014), this is a condition “when a person is valued primarily in terms of his/ her physical attractiveness,” which leads individuals to view themselves in an objectifying way (p. 284). When an adolescent creates a social media profile, he or she is directly subjected to the objectification theory through the gaze of other users’ comments. Also, these teens can easily access one another’s profiles and participate in a large community. As Reilly and Parsa (2019) note, some media providers engage users by creating common trends and following the current youth interests. As a result, evaluating one’s physical attraction in comparison to others is a huge aspect of these applications.
Users receiving validation for their posts may look at others’ posts and wonder why they are not receiving as many likes or comments. In addition, picture-oriented applications have filters built-in so that users could easily manipulate their digital images. This allows them to easily see themselves with different looks and facial features and further incentivize teens to consider surgery. According to the existing data, many teenagers resort to the services of plastic surgeons due to trends in social media and opportunities to transform their appearances seen through filters (“Spike in teenagers,” 2018). The constant reminder about one’s body imperfections provided by media, as well as the normalization of self-hate toward imperfect bodies, leads young people to develop mental health issues, namely, anxiety ad depression, which culminates in the false idea of fixing the problem with plastic surgery. The fact that the specified decision not only fails to solve the problem but also solidifies it typically escapes young people. This trend is a real problem and statistics confirm this. Reilly and Parsa (2019) state that “55 percent of surgeons reported seeing patients who requested to improve their appearance in selfies” (para. 3). This, at first glance, the absurd fact is a given, which testifies to the complete immersion of the young people in the virtual environment. Adolescents can further personalize digital manipulation by using user-friendly apps such as Photoshop or Facetune (Reilly & Parsa, 2019). This serves as an additional driver that stimulates interest in changing appearance.
At the same time, although an online profile shows an idealized version of a user, a teen utilizing the editing software may start to feel one’s self-esteem drop because he or she realizes that followers like the edited version, and that they also like the edited version more. By easily seeing a version of themselves slightly altered to fit the societal beauty standard, increases their desire to modify their appearance and motivates them to have a quick fix through undergoing cosmetic surgeries. Social media affects adolescents’ self-esteem negatively because it creates an environment for users to constantly compare one another’s appearances and creates pressures for perfection.
As a former social media addict, I can attest to this theory. Once I created a profile in Instagram and started posting my photos, I got over 100 likes in less than a day. I instantly became obsessed with the feeling of getting the notification that someone new had liked my picture. I started feeling that I needed more validation that people liked me. My life soon started to revolve around Instagram. I felt that I always needed to look perfect when I went out, and I canceled my plans if I did not feel good about myself that day. I felt upset with myself whenever my photos did not reach the same amount of likes and comments as my friends because it made me feel inferior and ugly.
The feeling of anxiety was exacerbated for me on Instagram because it was so easy to see how popular you were through the number of likes and comments. I had frequent thoughts of plastic surgery and started to believe that I would have a bigger following if I was prettier. The described phenomenon can be explained by the Social Comparison Theory since it allows viewing how people tend to copy the behaviors and appearances that are lauded to the greatest extent socially. Once Instagram removed the number of likes on all user profiles, fortunately, my obsession with this app faded. Looking back, I realized how easy it is to develop an unhealthy obsession with appearance through these applications. I experienced the objectification theory, social comparison theory, and self-esteem issues all in a couple of months. Social media had the biggest impact on my desire to change my looks. If Instagram had not removed the number of likes, I could see how my unhealthy obsession with appearance would have continued to grow to the point where I would most likely take drastic measures. I asked my friend if social media played a role in her undergoing cosmetic procedures. She mentioned, “Of course, I use Facetune to see what I would look like after my surgery and I learn about new cosmetic trends through Instagram”. It makes me feel conflicted because I know how much I love social media, but the self-esteem issues that these applications could cause are extremely detrimental. Maybe if there was more celebration of flaws and less emphasis on perfection, it could show teens how to start loving their insecurities by leading by example. It seems that, for me, the unwillingness to seek PS was defined by the implicit suspicion of the surgery being only a superficial attempt at disguising a more sinister underlying psychological issue. However, for my friend, who was desperate to receive approval from her peers due to low self-esteem, the support of a psychologist was clearly needed. However, unwilling to accept the presence of a self-esteem issue, she resorted to PS instead.
Celebrity Influence
The influence of celebrities on the formation of beauty standards among teens is significant because many adolescents have idols whom they consider ideals in terms of appearance. The role of social media amplifies this impact, and celebrity accounts become trend-defining markers among teenagers (“Spike in teenagers,” 2018). Furthermore, there has been an increasing number of younger celebrities undergoing cosmetic procedures and glamorizing this online. Adolescents who observe the life of their idols come to the idea that if celebrities close to their age can transform their appearance, they are also capable to do this. Duffy (n.d.) cites the research that proves that teenagers not only imitate the behavior or style of their idols but also strive to look like them, and plastic surgery is a tool to achieve the ultimate goal. Moreover, the transformation of faces is not the only trend because body modifications are also heavily glamorized. For instance, James Charles is an influencer who promotes gluteal implants, and Daisy Keech is a celebrity who promotes breast augmentation. As a result, teenagers are ready to undergo serious surgical interventions to look like their idols. A notable case of this was when Kylie Jenner who was 15 at the time, admitted to having lip fillers in 2015. This sparked a lip filler frenzy that set a record high number of lip procedures during that year. In fact, according to the Plastic Surgery Report by the American Society of Plastic Surgeons, there was an 8 %increase in lip-related procedures, compared to 2014, amongst patients ages 13-19 (“2015 Plastic Surgery Statistics” n.d.).
Arguably, teenagers are nowadays in quite a different world than their parents and even younger adults used to live in several years ago. With the PS industry gaining power, its promotion campaigns and media influence are growing increasingly aggressive, which contributes to the loss of self-esteem and the development of self-doubt in young people. To provide support for teenagers who seek to address their esteem issues with PS, the assistance of qualified experts in psychology is required along with a vast and all-encompassing media campaign. Thus, the propensity toward using PS as a tool for managing mental health concerns will be reduced.
Additionally, plastic surgeons themselves have accounts on social networks where specialists share their experience of the work done and use celebrity profiles for advertising and attracting the target audience. It is important to note that most surgeons offer to fix any complications or in rare cases refund the patient in exchange for not writing a negative review of the botched surgery. This is because when a patient comes across a bad review, they will feel doubt and find another surgeon. Bad reviews have the potential of ruining business for plastic surgeons so they will actively censor it. This type of censorship distorts the accurate success rate by only highlighting the positive surgeries. I believe that the lack of negative reviews and experiences will cause more people to have a false perception of the real success rate, and therefore increase the likelihood of individuals potentially choosing the wrong surgeon. Transparency is a major issue with many plastic surgeons.
Peer Pressure and Bullying
Apart from the positive reinforcement techniques that media uses to trick young people into performing PS, negative reinforcement is also very prominent. As a result, bullying becomes one of the reasons that induce teenagers to transform their bodies through plastic surgery. Being convinced by the media what beautiful people should look like, teenagers succumb to bullying those that do not fit the stereotype. Young people are extremely susceptible to peers’ opinions, and those adolescents who do not fit into the generally accepted framework of their culture are humiliated. The aspect of beauty is of the utmost importance, and in the case of congenital or acquired defects, teenagers may be under pressure due to inadequacy by modern standards. In their study, Knoll et al. (2015) assess the behavior of three age groups from the perspective of the social-influence effect – children, adolescents, and adults. Based on the results of the research, children tend to imitate adults (Knoll et al., 2015). Teens, in turn, tend to compare their opinions with those of peers and change to conform because the assessment of their age group representatives is the most important for them (Knoll et al., 2015). As a result, the trend of teenagers’ influence on one another is proved by this research on social interaction, and bullying is one of its negative manifestations.
For some adolescents, the desire to resort to the services of plastic surgeons is an opportunity to gain peers’ affection. According to the American Society of Plastic Surgeons (2017), teenagers are more likely to opt for surgeries when they have experienced bullying or are currently experiencing it. According to the organization, among the interviewed teenagers, the decision to undergo an operation was expressed by those who were humiliated by peers at least once (American Society of Plastic Surgeons, 2017). The situation is complicated by trends on social media when some celebrities show the outcomes of their body transformations (“Spike in teenagers,” 2018). I understand the feeling of wanting to change after being told that something is not right about yourself. When I was in elementary school, I was frequently bullied for wearing glasses. My classmates and friends used to call me four eyes and sometimes broke my glasses. Although this may not be as severe as the type of bullying that others endure, the name-calling took a toll on me. In the beginning, I just refused to wear glasses, despite having extremely poor vision. Once I switched to contact lenses, I barely took them out because I did not want to be seen wearing glasses. I would even sleep with my contact lenses on most days. My eyes were constantly dry and in pain, but I thought it was better than wearing glasses. The bullying I faced was not bad, but even then, it put me off from wearing glasses for 10 years of my life. I could easily change what I was being criticized for, but when I imagine being humiliated for something that I could not change without surgical intervention, I see surgery in a different light.
Approaching the PS from the perspective of it being a solution to “actual defects,” one will also have to admit that the surgery seems to be unnecessary. Namely, PS sees to heighten the threshold for social acceptance of people with unique appearances. Thus, in the situations where plastic surgery is not used to address a health issue, it seems to be completely unnecessary and hindering the promotion of acceptance of people with unique physical characteristics.
In some studies, the positive impact of plastic surgery on reducing bullying is considered. For instance, Derrick et al. (2017) note that in 2013, approximately 30% of adolescents in the United States were overweight (p. 179). Surgery, in turn, can help maintain a healthy weight and improve self-esteem in these teens. Lee et al. (2017) also note a positive correlation between plastic surgery and the improvement of adolescents’ psychological state. The sociocultural environment plays an essential role in self-perception, and an opportunity to earn peer recognition through this method is potentially effective. Most teens who had undergone cosmetic intervention were happy with the results and state that they would have done it earlier if they had the chance. When learning about my friend’s initial procedure at the age of 14 for double eyelid surgery, she explained how she felt like a new person. Her friends complimented her on how big her eyes were and that she was very pretty and looked like a doll. She felt happy, confident, and engaged more actively with friends. Hearing how much her self-esteem changed, makes me question my stance on plastic surgery. Surgery could change an individual’s life significantly, but it could also be extremely detrimental. It is hard to weigh whether or not it is right for someone because no one knows the outcome and implications of surgery completely. At the same time, it seems that PS is a bit extreme since it involves eliminating any physical traits perceived as flaws. The described attitude does not align with the reasonable use of PS for managing health issues such as a cleft lip, which may cause respiratory issues or similar physical health issues.
Examining Beauty Standards in Asia and America
The trend of plastic surgery among adolescents is widespread both in Asia where surgical interventions are closely included in teenage culture and America. At the same time, when comparing the beauty standards of the two regions, one can point out specific features that are characteristic to the individual countries and cultures. For instance, in South Korea, girls receive certificates for plastic surgery as a graduation present, and this is a popular phenomenon in the country. According to Ching and Xu (2019), in China, about 70% of female students and high school pupils use surgery to correct parts of their bodies and faces (p. 7). In South Korea, as Yoon and Kim (2020) state, in 2015, 5% of the country’s total population underwent such procedures, which may be explained by a cultural trend in pursuit of a generally accepted ideal (p. 230). This figure is extremely high, which indicates the recognition and normalization of cosmetic surgery by Asian people. The implicit question here is why PS defines the lives of Asian people to such a huge extent as opposed to their Western counterparts.
In terms of beauty standards, Asians adhere to specific patterns, and plastic surgery is a means of achieving the desired results. Yoon and Kim (2020) note that in South Korea, among the most common procedures, one can single out eyelid lift, rhinoplasty, face-lifting, skin whitening, and V-line face. In the west, some other surgical procedures are more widespread. According to the American Society of Plastic Surgeons (2019), in 2019, breast augmentation ranked number one in this list. Liposuction, rhinoplasty, Botox injections, and fillers are also common procedures in the United States (American Society of Plastic Surgeons, 2019). Paul (2018) argues that in 2017, “some 229,000 cosmetic procedures were performed on patients aged 13 to 19” (para. 5). However, it is thought that this number is in reality much higher since the majority of adolescent plastic surgery numbers remain largely unreported. Still, this number confirms the widespread popularity of plastic cosmetology in the US.
Regarding the perception of beauty standards and attitudes towards plastic surgery, there are differences among residents of the two parts of the world. In addition to distinctive cosmetic trends, one can note different nuances and features of trend following. For Westerners, plastic surgery is more stigmatized and less important than for Asians who may experience significant discomfort due to the inconsistency of appearance parameters with common views. In such countries as Korea, many teens who have not undergone cosmetic procedures may find limited job prospects compared to their peers that have and, therefore, experience an inferior quality of life (Park, 2014). In the USA, in turn, there are body positive movements, for instance, Victoria’s Secret and Abercrombie & Fitch who once only featured the tall skinny models on their advertisements, have now shifted the focus of the message by featuring more size-inclusive models. They help the target audience get rid of obsessive complexes associated with the inability to meet beauty standards. Therefore, in terms of mental perception, Asian culture for plastic surgery is much stricter and more biased than the western one. Nevertheless, the comparison makes it clear that the topic of the trend for voluntary correction of appearance is relevant in different parts of the world and deserves wide discussion. Therefore, the proposed research question about the potential impact of plastic surgery on the psychology of adolescents is revealed in a global context.
Additionally, through my interview with peers, I have discovered that Japan, China, and Korea do not request teenage patients to undergo any mental health check before their procedure. This may explain the high rate of plastic surgery addiction in Asian countries because doctors may be performing on mentally unstable patients. In contrast, America recommends a full physical and mental health screening before the procedure, as well as more time spent during counseling. Following America’s standard, the solution for much of Asia’s negative consequences bred from plastic surgery seems to lie in more emphasis on mental health. In this case, it seems like the appropriate solution is to require and mandate a mental health screening for all patients (not only teens but also adults).
Ethical Issues
Although there are positive aspects of plastic surgery among adolescents, some ethical issues need to be taken into account. One of them is the responsibility for a decision to undergo surgery. Bermant (2005) considers this topic and notes that parents who are supporters of their children’s surgeries act as guarantors of safety and should consider all potential risks. In many legislations, age-related immaturity is a key barrier to plastic surgery, and only adults are allowed to authorize adolescents for appropriate interventions. Del Rio et al. (2017) argue that only parents and healthcare providers can give permission. This limitation is reasonable since an underdeveloped body and insufficient life experience are objective reasons for restraining a desire to transform one’s body or face. Therefore, from an ethical standpoint, adolescents should not be trusted to make decisions about this topic on their own.
There are several points of view regarding the issue of the admissibility of parents’ participation in this issue. As Rohrich and Cho (2018) note, if adults are aware of their child’s problems associated with bullying or any other social hardship, this may be a reason to consent to surgery. In doing so, parents help a teen to relieve stress and, at the same time, build productive interaction, thereby acting as an authority in the family. However, one can argue that parents allowing their child to undergo surgery at a young age sends a harmful message that their child is not good enough and teaches them to become reliant on surgery for their insecurities. At the same time, Rohrich and Cho (2018) remark that in the case of an unsuccessful surgery or other potential problems, adults may be wrong since the responsibility for making the final decision lies with them. The key issue lies here, the outcome of surgery and long-term effects can not be predicted with 100% accuracy. This means that in addition to being unanimous about plastic surgery, adults should consider all the options and draw conclusions based on careful analysis. Otherwise, parents may be those who allowed the psychological trauma of a teenager and did not provide the anticipated results after surgical intervention.
Social pressure is no less significant ethical factor than the aforementioned ones. Choate (2015) analyzes how stereotypical certain social trends can be and argues that appearance is one of the defining values in adolescence. Therefore, to decide on surgery, both parents and healthcare providers should explain to an adolescent that rushing to make such a decision is fraught with frustration in the future. This social stereotype is relevant at a young age, but over time, people tend to become happier and more self-confident with themselves. Therefore, when analyzing the need for plastic surgery, I believe that a teenager should understand whether he or she will adhere to similar views on one’s problem in a few years. If the answer is negative, the ethical side of the issue justifies the complete absence of the need for the services of a plastic surgeon.
Potential Risks
One of the main factors that justify the controversy of plastic surgery among adolescents is a health risk. Hilliard (2020) analyzes potential threats to unsuccessful surgery and mentions infections, collapsed muscles, scarring, tissue death, blood clots, and some other dangerous manifestations. Also, with the rise in popularity of picture-oriented social media apps, mental illness such as body dysmorphic disorder (BDD) has been increasing amongst teenagers (social media does not necessarily cause BDD, but it exacerbates the symptoms). BDD develops during early adolescence and “causes a person to obsess over real or imagined “flaws” in their appearance” (Hilliard, 2020, para. 8). This disorder affects the individual’s lifestyle by causing depression, withdrawal from society, and self-mutilation. BDD is often co-occurring with plastic surgery because a patient who undergoes a cosmetic procedure and experiences an initial positive reaction will view plastic surgery as the source of one’s happiness. This then develops into plastic surgery addiction as the more surgeries a patient undergoes, the greater is the chance of an unsuccessful operation. Additionally, constantly undergoing surgical procedures may develop into the patient developing an additional addiction to painkillers.
If a surgeon is against performing surgery on a patient with BDD, the latter will look for less qualified specialists or in an extreme case conduct surgery on themselves. Moreover, as Khanna and Sharma (2017) note, for adolescents with BDD, unsuccessful plastic surgeries can worsen their condition critically. Firstly, the incorrect or unsuccessful operation can aggravate emotional depression and cause the development of comorbid psychological disorders. To cope with this emotional distress, these patients will look for other sources to numb their pain, such as turning to alcohol, drugs, self-mutilation, or oftentimes suicide. Secondly, a teenager can become the target of even more severe bullying if a surgery does not correct a specific defect. Kita (2020) states that these outcomes are objective reasons to think about whether such prospects are acceptable and whether it is worth spending money to put up with the attendant problems. To minimize the risk of plastic surgery addiction, I think that surgeons need to put an emphasis on mental health and require teenagers in particular to provide a mental health check that is verified through a counselor or therapist before surgical intervention.
Risks are increased if a patient has specific physiological characteristics that may affect the outcomes of plastic surgery. Yeslev et al. (2017) mention obesity, harmful addictions, congenital chronic diseases, and other factors that can complicate the process of transformation of certain body parts. If a teenage patient has a specific health problem that potentially complicates the upcoming operation, this is a good reason to consider the decision again and undergo the necessary examinations. However, even in this case, there is no guarantee of a successful intervention. As Singh (2015) remarks, secondary procedures that may be required to recover can be more time-consuming and costly than the initial intervention. Therefore, it is clear to me that a comprehensive assessment of a body’s readiness for plastic surgery is a crucial condition for preventing risks.
Post-Surgery and Adolescents’ Views
As evidence, the results of selected academic studies may be included, as well as the opinions of those adolescents who underwent plastic surgery. In their work, Crerand and Magee (2013) provide unique statistics: among females who have undergone breast augmentation, the risk of suicide is two to three times higher than among those women without body transformations. This is linked to plastic surgery patients as a whole having a “higher incidence of body dysmorphic disorder, which carries with it a higher risk of suicide” (Reddy and Coffery, 2016, p.g 1). Crerand and Magee (2013) note that adolescents with mental instability and diagnosed cognitive impairments should be thoroughly tested before resorting to the services of specialized healthcare professionals. Otherwise, a post-surgical condition will be complicated crucially and cause additional psychological problems. The example of an 18-year-old Chinese girl who underwent double eyelid surgery is a warning to all those who decide to correct their appearance. Chan (2018) describes the case of Xiaobai and notes that the girl has experienced pain more than a year after the surgical intervention. Despite the family’s complaints, this situation was difficult to predict since the fine muscles of an eye are susceptible to any external influences, and Xiaobai’s case is not unique. Chan (2018) notes that the representatives of the clinic in which the girls underwent the operation intended to carry out additional interventions to eliminate the defect that had arisen. However, there is no guarantee that the girl’s eye will function as before. This example proves the risks that plastic surgery carries to young people. Xiaobai’s case confirms the prospect of significant post-operative recovery costs, and in the case of a failed surgical intervention, both money and health are affected. Griffiths (2019) gives the example of an Iranian girl who has undergone dozens of surgeries to look like her idol, Angelina Jolie. Today, her appearance is discussed on the Internet as a visual aid to what consequences a passion for plastic surgery can bring.
When speaking about the possible benefits of plastic surgery for eliminating real defects in appearance, one should note that there are nuances that do not depend on the quality of the work done by a surgeon. Simis et al. (2002) note that, even though in most cases, patients are satisfied with the results of transformations, there are cases that confirm adolescent dissatisfaction with the results of operations. In particular, Simis et al. (2002) give the example of a girl who claims that the initiative to change her appearance was not her own, and her parents pushed her to this decision. This is more frequent and common in Asia than in America. This premise allows asserting that the perception of the results of surgical interventions depends not only on a specific visual outcome but also on the expectations of patients themselves. In this regard, I believe it is important that parents and other stakeholders should take adequate participation in the life of an adolescent and coordinate his or her interests and intentions to prevent unwanted post-surgery outcomes.
Conclusion
Due to high beauty standards and free access to the services of practical surgeons, many adolescents can transform their bodies and face, which, in turn, causes parents’ and healthcare providers’ concerns. The answer to the research question is that current trends threaten teenagers’ health. A number of factors influence adolescents’ plastic surgery preferences – social media, bullying, peer pressure, childhood experience, and celebrities’ activities. Differential approaches to body transformation in the east and in the west are not an obstacle for adolescents, although significant ethical issues arise, for instance, the right to surgeries or the responsibility of adults. The research process has allowed giving real examples that confirm the risks of the voluntary transformation of appearance. The examples of individual adolescents and my own observations prove that the threats of operations can appear regardless of the competence of medical specialists. In this regard, I have drawn a parallel between the findings of my research and individual experience and determined that the trend of plastic surgery among teenagers is determined by external factors significantly. It appears that PS is currently promoted as an easy and quick fix for a problem that requires a much more nuanced solution, namely, that one of supporting self-esteem in young people. Moreover, with the financial gain involved, the PS industry is likely to be eager to promote the content that reinforces the false notion of beauty, thus persuading numerous young people to undergo invasive surgeries. The specified issue seems to be particularly topical for Asian culture, where the power of prejudices still shapes the image of a perfect face and body, both for women and men.
Today, women are under strong social pressure to pursue high beauty standards, and this aspect is one of the key drivers of all the negative implications. The research results confirm that various external influences, including social media, celebrity impacts, or bullying are stimuli that dictate the fashion of appearance. These stimuli, in turn, drive an unhealthy interest in plastic surgery among adolescents around the world, and individual cases explain high risks. All the findings prove that the research question is valid and objective, and numerous arguments in support of restrictions on plastic surgery among adolescents confirm the threats to their physical and psychological health. The conclusions have a practical value, and the main implication of the research is an opportunity to engage stakeholders to reduce the negative impact of external factors on adolescents’ interests to voluntary transformations of their appearance. I hope adolescents will be able to recognize the pointlessness and harm of plastic surgeries, as well as the ideology that incites them to view plastic surgeries as the solution to their self-esteem issues. By addressing the crisis of self-perception as such instead of trying to fit the stereotypes portrayed in media, young people will be able to gain confidence and improve their self-esteem.
References
Abraham, A., & Zuckerman, D. (2011). Adolescents, celebrity worship, and cosmetic surgery. Journal of Adolescent Health, 49(5), 453-454.
American Society of Plastic Surgeons. (2017). Bullying is linked to increased desire for cosmetic surgery in teens.
American Society of Plastic Surgeons. (2019). Plastic surgery statistics report. Web.
Bermant, M. A. (2005). Ethics of cosmetic plastic surgery in adolescents. AMA Journal of Ethics, 7(3), 257-261.
Bureau of Labor Statistics. (2019). Physicians and surgeons.
Chan, E. (2018). Botched plastic surgery to enlarge Chinese teens’ eyes leaves her in pain for a year. South China Morning Post.
Ching, B. H. H., & Xu, J. T. (2019). Understanding cosmetic surgery consideration in Chinese adolescent girls: Contributions of materialism and sexual objectification. Body Image, 28, 6-15.
Choate, L. (2015). Relentless cultural pressures for today’s girls. Psychology Today.
Crerand, C. E., & Magee, L. (2013). Cosmetic and reconstructive breast surgery in adolescents: Psychological, ethical, and legal considerations. Seminars in Plastic Surgery, 27(1), 72-78. Web.
Del Rio, A., Rinaldi, R., Napoletano, S., & Di Luca, N. M. (2017). Cosmetic surgery for children and adolescents. Deontological and bioethical remarks. La Clinica Terapeutica, 168(6), e415-e420. Web.
Derrick, D., Crawford, L., Sheridan, J., Buckspan, R., Delgado, A., Gualy, S., Vo, D., Salisbury, M., & Ersek, R. A. (2017). Teen aesthetic surgery may eliminate bullying. Plastic and Aesthetic Research, 4(10), 178-184. Web.
Duffy, M. (n.d.). Adolescents, celebrity worship, and cosmetic surgery. National Center for Health Research.
Hilliard, J. (2020). Plastic surgery addiction – Body dysmorphic disorder. Addiction Center. Web.
Khanna, A., & Sharma, M. K. (2017). Selfie use: The implications for psychopathology expression of body dysmorphic disorder. Industrial Psychiatry Journal, 26(1), 106-109. Web.
Kita, N. (2020). The risks & rewards of plastic surgery. Verywell Health.
Knoll, L. J., Magis-Weinberg, L., Speekenbrink, M., & Blakemore, S. J. (2015). Social influence on risk perception during adolescence. Psychological Science, 26(5), 583-592.
Lee, K., Guy, A., Dale, J., & Wolke, D. (2017). The adolescent desire for cosmetic surgery: Associations with bullying and psychological functioning. Plastic and Reconstructive Surgery, 139(5), 1109-1118. Web.
Nesbitt, A., Sabiston, C. M., deJonge, M., Solomon-Krakus, S., & Welsh, T. N. (2019). Barbie’s new look: Exploring cognitive body representation among female children and adolescents. PloS One, 14(6), e0218315. Web.
Paul, K. (2018). More than 200,000 teens had plastic surgery last year, and social media had a lot to do with it. Market Watch.
Reddy, V., & Coffey, M. J. (2016). Plastic Surgery and Suicide: A Clinical Guide for Plastic Surgeons. Web.
Reilly, M., & Parsa, K. (2019). Social media and the rising trend of cosmetic surgery. Psychology Today. Web.
Rohrich, R. J., & Cho, M. J. (2018). When is teenage plastic surgery versus cosmetic surgery okay? Reality versus hype: A systematic review. Plastic and Reconstructive Surgery, 142(3), 293e-302e.
Simis, K. J., Hovius, S. E., de Beaufort, I. D., Verhulst, F. C., & Koot, H. M. (2002). After plastic surgery: Adolescent-reported appearance ratings and appearance-related burdens inpatient and general population groups. Plastic and Reconstructive Surgery, 109(1), 9-17.
Singh, K. (2015). Cosmetic surgery in teenagers: To do or not to do. Journal of Cutaneous and Aesthetic Surgery, 8(1), 57-59. Web.
Spike in teenagers opting for cosmetic surgeries. Reason? Bullying and social media influence. (2018). The New Indian Express. Web.
de Vries, D. A., Peter, J., Nikken, P., & de Graaf, H. (2014). The effect of social network site use on appearance investment and desire for cosmetic surgery among adolescent boys and girls. Sex Roles, 71(9-10), 283-295. Web.
Yeslev, M., Gupta, V., Winocour, J., Shack, R. B., Grotting, J. C., & Higdon, K. K. (2017). Safety of cosmetic surgery in adolescent patients. Aesthetic Surgery Journal, 37(9), 1051-1059.
Yoon, S., & Kim, Y. A. (2020). Cosmetic surgery and self-esteem in South Korea: A systematic review and meta-analysis. Aesthetic Plastic Surgery, 44(1), 229-238.